Interpretive variability of dobutamine stress echocardiography (DSE) and stress single-photon emission computed tomography (SPECT) has been previously investigated. However, no study has directly compared the variability of these techniques in the same patient population. We directly compared the interpretive reproducibility of DSE and stress SPECT in patients undergoing both types of pharmacologic stress imaging. Before discharge, simultaneous DSE and SPECT was performed in 56 patients early after a first acute myocardial infarction. Intra- and interobserver concordances were evaluated by exact agreement and kappa statistic. Intraclass coefficient of correlation was used to assess intra- and interobserver reproducibilities of segmental score analysis. Intraobserver agreement percentages in the identification of patients with ischemia were 98% for SPECT and 91% for DSE (p = NS) and kappa values were excellent (>0.80) for both techniques. Interobserver agreement was higher (p <0.01) for SPECT (96%) than for DSE (79%). Similarly, kappa value was excellent for SPECT (0.92) and only moderate for DSE (0.56). Finally, the intraclass coefficients of correlation for intra- and interobserver reproducibilities were higher for SPECT (0.98 and 0.97, respectively) than for DSE (0.80 and 0.71, respectively; p <0.001 for both). In conclusion, after uncomplicated acute myocardial infarction, stress SPECT imaging has a better interpretive reproducibility than DSE.